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Prevention Program Effective in Reducing Patient Burden of Foot Dermatoses


The OCCUPES study examined the patient burden associated with foot dermatoses and work-related skin diseases and the implications of a prevention program.

A recent prospective cohort study1 known as OCCUPES found that a prevention program employing patient health education techniques was effective both in identifying and reducing the patient burden of foot dermatoses and work-related skin disease (WRSD).

H_Ko/Adobe Stock
H_Ko/Adobe Stock

The program was created for patients with WRSD suffering from foot dermatoses who partake in secondary and tertiary methods of prevention. Investigators cited prior intervention approaches in the literature aimed at prevention, which had success in addressing the burden of WRSD and dermatoses. However, these programs have primarily addressed hand dermatoses, and little research has been done to explore the implications of these programs when addressing other bodily dermatoses.

Patients with WRSD (n=231) were invited to participate in 1 of 2 programs, including a secondary individual prevention program (SIP) for those with mild or early symptoms of WRSD (n=25), a tertiary individual prevention program (TIP) for patients with more severe cases of WRSD (n=169), and a SIP aimed at early or mild foot dermatoses (FD-SIP) (n=37). These prevention programs were specialized to include features such as:

  • TIP: Inpatient intervention phase (diagnostics, treatment, patient education, selection of personal protective equipment), outpatient intervention phase (absence of work for a 3-week period), and add-on training (similar to SIP)
  • SIP: Skin protection seminars, skin examinations, health educator counseling, face-to-face training related to prevention and occupational footwear recommendations
  • FD-SIP: Face-to-face foot dermatoses counseling, health education aimed at pathogenesis and prevention, skin examinations, and recommendations for prevention and occupational footwear

Key Takeaways

  • A patient health education-based prevention program effectively identified and reduced the patient burden of foot dermatoses and work-related skin disease (WRSD).
  • Prior intervention approaches for WRSD have primarily addressed hand dermatoses, indicating a need for tailored interventions for other bodily dermatoses.
  • Study findings emphasize the importance of tailored interventions, health education, proper footwear, and counseling in addressing foot dermatoses and WRSD, with potential for sustained improvements in patients' conditions.

Between January 2016 and December 2019, patients were invited to participate in the study, which was conducted at Osnabrück University in Germany. Investigators conducted assessments via a questionnaire and a dermatologic assessment, wherein patients were evaluated in accordance with several grading scales. These included the Osnabrueck Foot Eczema Severity Index (OFSI), Dermatology Life Quality Index (DLQI), and Visual Analogue Scales (VAS).

Researchers found that common foot dermatoses included atopic foot eczema, irritant contact dermatitis, allergic contact dermatitis, hyperkeratotic foot eczema, psoriasis, and tinea pedum.

In the year leading up to the study’s initiation, patients reported use of emollients, topical corticosteroids, psoralene, ultraviolet A irradiation, topical antimycotics, tap water iontophoresis, and topical antiperspirants as treatment.

A greater number of participants with work-related foot dermatoses wore special shoes or boots as occupational footwear (n=85%) than those whose foot dermatoses were unrelated to their work environment (n=68.4%). Additionally, fewer patients with work-related foot dermatoses wore cotton socks, and a higher proportion of these patients reported needing to change their footwear or socks during work shifts and reported sweating as their chief complaint about occupational footwear. Symptoms in this patient population were also more frequent, including itch, pain when walking, and smell. The intensity of pain associated with foot dermatoses in accordance with VAS grading was also higher in this group; those whose foot dermatoses were work-related was 2.68 ± 3.06, while those whose foot dermatoses were unrelated to occupation was 2.01 ± 2.66.

All patients received questionnaires at 6 months and 1 year post prevention program participation; these questionnaires mirrored that of the baseline questionnaire.

“The burden of FD [foot dermatoses] in patients with WRSD is considerable and work-related FD might be underreported. The presented factors associated with FD and shortcomings in preventive measures are addressed in the established intervention,” according to study authors Brans et al. “Patients with FD may benefit from selection of adequate footwear and matching socks as well as health education and individual counselling increasing their knowledge and motivation to properly care for their feet. The follow-up data of this prospective study will show if the programme is able to provide sustained improvements in these patients.”


  1. Brans R, John SM, Wilke A, Hübner A. Programme for prevention of foot dermatoses in patients with work‐related skin diseases: Baseline Data and first results of a prospective cohort study OCCUPES. Contact Dermatitis. Published online August 20, 2023. doi:10.1111/cod.14400
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